I am Forbes' Opinion Editor. I am a Senior Fellow at the Manhattan Institute for Policy Research, and the author of How Medicaid Fails the Poor (Encounter, 2013). In 2012, I served as a health care policy advisor to Mitt Romney. To contact me, click here. To receive a weekly e-mail digest of articles from The Apothecary, sign up here, or you can subscribe to The Apothecary’s RSS feed or my Twitter feed. In addition to my Forbes blog, I write on health care, fiscal matters, finance, and other policy issues for National Review. My work has also appeared in National Affairs, USA Today, The Atlantic, and other publications. I've appeared on television, including on MSNBC, CNBC, HBO, Fox News, and Fox Business. For an archive of my writing prior to February 2011, please visit avikroy.org. Professionally, I'm the founder of Roy Healthcare Research, an investment and policy research firm. In this role, I serve as a paid advisor to health care investors and industry stakeholders. Previously, I worked as an analyst and portfolio manager at J.P. Morgan, Bain Capital, and other firms.

GOLDEN, CO - SEPTEMBER 13: U.S. President Barack Obama (R) shakes hands after speaking at a campaign event September 13, 2012 in Golden, Colorado. Obama has made several campaign stops in Colorado, which is a hotly contested state in this year's election. (Image credit: Getty Images via @daylife)

With the Presidential election one week away, it’s worth reviewing how Obamacare will impact the residents of key swing states. In Colorado, as elsewhere, Obamacare will drive up the cost of private health coverage, especially for those who buy insurance on their own. One of Obama’s key health-care advisers, Jonathan Gruber, found that by 2016, individual premiums in Colorado will increase by an average of 19 percent. In addition, Obamacare will deeply cut Medicare Advantage for more than 225,000 Colorado seniors enrolled in the program. And 29 percent of Colorado physicians say that they will place new or additional limits on accepting Medicare patients. Read on for more details.

(DISCLOSURE: I am an outside adviser to the Romney campaign on health care issues. The opinions contained herein are mine alone, and do not necessarily correspond to those of the campaign.)

Individual-market premiums to increase by 19 percent on average

In January of 2012, Jonathan Gruber, an MIT economist who was in many ways the architect of Obamacare, conducted research to support the development of Colorado’s state-based Obamacare insurance exchange. In his report, Gruber writes that the Affordable Care Act “raises prices in the individual market, with the average premium rising by 19%” by 2016, relative to prior law. Gruber published reports for two other states, Minnesota and Wisconsin, in which he projects that Obamacare will increase individual-market premiums by 29 and 30 percent, respectively.

Gruber’s Colorado report makes clear, as do his similar reports for other states, that Obamacare’s web of insurance mandates and regulations will dramatically increase the cost of individually-purchased insurance.

As I discussed earlier this year, Gruber’s Colorado report goes into considerable detail as to the key aspects of Obamacare that, in his opinion, will affect premium costs:

The requirement that all insurance plans cover “certain essential benefits;”

The mandate that all plans meet a “minimum actuarial value” of 60 percent (i.e., that beneficiaries bear out-of-pocket responsibility for a maximum of 40 percent of their benefit costs);

Requirements that insurers charge similar rates to the young and the old (community rating).

But while Gruber is correct that these provisions in the ACA will affect insurance premiums—by and large increasing them—what’s most notable about his report is what he ignores about the ACA. In other words, his estimate that premiums will only increase by 19 percent is a conservative one.

“It is important to recognize some limitations in our modeling of prices,” writes Gruber in the report. “In particular, given publicly available data we cannot incorporate the effects of the ban on pre-existing conditions exclusions. This ban will cause a rise in premiums as insurers are forced to cover conditions that they had previously excluded. In addition, there are new premium taxes on insurers that will raise premium rates…Overall, we cannot predict the net impacts of these factors on premiums without more analysis.”

In other words, the key aspect of Obamacare’s takeover of the individual insurance market—its requirement that insurers take all comers, regardless of prior health status—is not accounted for in Gruber’s model, despite the fact that there isn’t a health economist alive who doesn’t think that this “guaranteed issue” provision has the potential to dramatically increase premiums for everyone else.

Some Obamacare defenders try to argue that these cost increases don’t matter, because a slice of the low-income population will benefit from the law’s subsidies. But if you’re not eligible for subsidies, or only partially eligible, you will be exposed to the law’s dramatic increases in the cost of insurance. And remember that Obamacare has an individual mandate, which will force most Americans to absorb these higher costs.

Obamacare to cut Medicare by $9,936 per Colorado retiree

Obamacare cuts Medicare by $716 billion between 2013 and 2022 in order to pay for part of the law’s $1.9 trillion in new health-care spending for younger people over the same time frame. My co-blogger Robert Book and Michael Ramlet have published a paper for the University of Minnesota showing that Colorado’s share of those Medicare cuts is $6.6 billion. This year, Colorado has 667,277 Medicare enrollees, which means that these cuts amount to $9,936 for every senior in the state.

Robert Book published another paper, this time with former White House budget official James Capretta, detailing Obamacare’s cuts to Medicare Advantage on a state-by-state basis. Robert and Jim found that, in 2017, Obamacare will cut $3,432 in Medicare Advantage services for every Coloradan enrolled in the program: a 26 percent cut. And 34 percent of Colorado’s seniors—226,449—are enrolled in Medicare Advantage.

Last month, the Physicians Foundation published one of the largest physician surveys ever conducted in the United States, with 13,575 respondents. They asked physicians a broad range of questions, including several about their views on Obamacare. 55 percent of Colorado physicians said that the Affordable Care Act made them “less positive about the direction and future of healthcare in America.” Only 25 percent said it made them feel more positive.

If Medicare fees decrease by ten percent or more—as the Affordable Care Act will require—29 percent of Colorado doctors say that they will place “new or additional limits” on accepting Medicare patients. 29 percent also say they’ll stop accepting Medicare patients altogether.

The survey also has bad news for Coloradans on other forms of insurance. 21 percent of Colorado physicians say that they’ll place new or additional limits on Medicaid patients as a result of the Medicare cuts; 23 percent also say they plan to raise fees on those with private insurance in order to compensate for the cuts.

And then there’s Obamacare’s tax increases

Finally, it’s worth touching on Obamacare’s tax increases. From 2013-2022, Obamacare increases taxes by $1.2 trillion, which amounts to $15,796 for the average family of four. Colorado’s share of those taxes is approximately $20 billion.

Obamacare’s defenders will claim that many of Obamacare’s taxes fall on corporations and upper-income individuals. But these taxes will get passed down to every American. For example, the law applies an excise tax to health insurance premiums, which insurers will be forced to pass down to individuals in the form of higher premiums. Analysts estimate that this tax could increase premiums by as much as 3 percent, or around $500 for the average Colorado family in 2014.

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How much would premiums rise if Obamacare had never been passed? Private insurers have monopolized by state. That makes them large enough to prevent any competition. Before Obamacare, during the last decade employers were facing double digit increases in their health insurance policies. What is a better solution? Medicare for all, but people should pay a percentage of their taxable income for coverage.

This email survey is completely biased due an absurdly low response rate of < 3%.

The survey was sent via email and successfully delivered to 600,000 physicians. Only 13,575 of them responded. It provides no meaningful information, as a 2.2% response rate implies that only those physicians who are angry or already exercised about this issue were likely to even take the time to respond.

While there is no universally accepted minimum response rate for publication of surveys in social science and health research, the American Association for Public Opinion Research asked journals about this issue and found that 60-80% response range is acceptable, while one journal said that below 20% is just too low. Based on this, I think a 2.2% response rate would be rejected out of hand. University of Wisconsin Survey Center also expects a minimum of 30-40% response rate for web surveys to be valid. (http://www.amstat.org/sections/srms/proceedings/y2003/Files/JSM2003-000638.pdf and http://oqi.wisc.edu/resourcelibrary/uploads/resources/Survey_Guide.pdf)

The Physicians Foundation has a conflict of interest because they represent physicians–at least they claim to. They have an incentive to scare policymakers and the public into believing that unless physician payments are increased there will be no access to health care for Medicare patients.

More generally, Avik needs to decide if he wants to grow up and be a journalist/reporter or remain another partisan mouthpiece for the Romney campaign (which could be the Romney administration come 2013). There has been zero even-handed analysis on this blog over the past 2 months. I know this is Forbes, but come on. Is Avik jockeying for a position in the administration? He knows better.

Healthcare in the US is more expensive than anywhere else in the entire world due to less restrictions on their healthcare market. This has failed to deliver a decent level of healthcare for the nation. Adam Smith, etc and ALL economists acknowledge the role of the state/regulation is to counterbalance unfettered capitalism.

Obamacare is clearly not great, but building on Republican ideas from the 90s, Romney’s ideas in the 00s, it is trying to steer US healthcare in a better direction.

You do not have to pay the penalty. Raise the number of dependents with your payroll department so they take less in taxes out of your check. Throw what they would normally take out into a savings account and gain a few extra pennies in interest (bonus). At tax time, write them a check for your taxes, minus Obamacare penalties. IRS can’t do sheet about it. The courts neutered them on it. Read the law. Control + F to “criminally prosecute”. They can not lein, or take any of your property, press charges, or use any means of collecting normal taxes to force you to pay it. The ONLY thing they can do is take it out of your return. Just ensure you don’t get one.

For many young and low income individuals, a high deductible is in reality the same as having no insurance. With the added issue of having to pay a monthly premium to an insurance company. Even with the no copay on preventative medicine such as physicals and exams, any follow up resulting from these visits, such as diagnostics and lab exams would be out of pocket until the patient reaches the deductible ceiling. So if you can’t afford a $600 MRI or $300 in blood work, you just can’t get the test. So instead of a grand plan to get everyone pay for insurance they may never get the benefit of using until they get a catastrophic illness they couldn’t afford to maybe prevent through test, lets go back to the original health care reform sales job of reducing actual medical care cost. If in fact everyone is to now be insured? Why can’t the hospitals and emergency care institution reduce their fees? The reasoning that hospitals give for $60 aspirins and $250 bandages is that it pays for the uninsured. If everyone is to now be insured there should be an automatic lowering of cost for care, thus allowing out of pocket expenses to be lower enabling more preventative medicine. Instead we talk about insurance reform now, not health care reform. Let’s get back to focusing on reducing the real problem. Out of control medical institution profiteering.